Speech recognition technology has been rapidly developing over the years. Companies like Dragon Naturally Speaking and Via voice have a significant market share.

There is a lot of concern within the Medical Transcription Community about the rapid adoption of Voice recognition technologies. Medical transcriptionists believe that Speech Recognition (SR) software will take over the industry and leave them out in the cold.

Well there is a lot of debate on all sides about this issue but the salient points stand as follows:

Yes, SR is rapidly developing in terms of accuracy and speed. However, the rates of accuracy can be 90% at best, in the case of the health-care industry. Health-care has a unique vocabulary that includes words that are not used in everyday life. Words that are complex to pronounce and sound very much like other words. For instance, how does the software figure out if you meant “French eyes” or “franchise; “urine” or “you’re in”; “dilate” or “die late”; “cauterize” or “caught her eyes”; “nitrate” or “night rate”, there are innumerable examples.

Thus speech recognition has some problems to surmount, problems that won’t exist for a human transcriptionist. There are some who say that speech recognition has reached a point of very high accuracy, only a few percentage points below human transcriptionists. But, is it worth sacrificing a couple of percentage points of accuracy for saving some money? After all, we are talking about human lives here. Cost should not be a primary consideration, and we should aim at very highest levels of accuracy.

There is a school of thought that says that a doctor can use speech recognition to render documents, and then can read and check the document for errors later on. So the question that now rises is: is the doctor supposed to do this sort of work? The doctor’s primary purpose is to treat patients. A doctor would want to spend as much time with the patients as possible, and does not have the time for data entry and document checking.

The extension of this argument is: if the doctor does not want to proofread the documents generated by the SR software, then he can hire Medical Transcriptionists to proofread and check the documents rendered by the SR software. But this defeats the purpose of having SR software. If you are hiring MTs to proofread the software rendered documents, then you might as well have MTs actually doing the transcription work for you. Why pay for the software and then hire MTs to proofread it for you? It doesn’t make sense. Even from the point of view of the MT, the transcriptionist would much rather prefer to listen to a dictation from an audio file and then type the words at a fast rate (most MTs can type at 50-plus WPM), rather than look at a flawed document and try to spot errors.

Thus, it is undeniable that SR software is a marvel of modern technology, but in the health-care environment, the marvel falls far short of what an actual human can do. It makes sense for health-care providers to have human MTs and be secure in the knowledge that they are being assured the highest levels of accuracy.

The United States has the most expensive health care system in the world, with per capita health expenditures far above those of any other nation. For many years, U.S. health care expenditures have been growing above the overall rate of inflation in the economy. A few experts have argued that high and rising costs are not such a serious problem. Most observers disagree with this view, pointing to the negative impact of employee health care costs on employers, the government budgetary problems caused by rising health care expenditures, and an association between high health care costs and reduced access for individuals needing health services.

Several explanations have been offered for high and rising health care costs. These include the perspectives that high and rising costs are created by forces external to the health system, by the weakness of a competitive free market within the health system, by the rapid diffusion of new technologies, by excessive costs of administering the health system, by the absence of strong cost-containment measures, and by undue market power of health care providers.

For the first time in history, US citizens will be required to purchase health insurance by law. This bill is a significant achievement by the Obama administration. They have been able to pass a sweeping health legislation where previous presidents have been unable to do so for decades.

Reuters has a very succinct and simple article that has an explanation of the what the bill means to ordinary Americans. We are quoting certain paragraphs of the report below.

We point out 4 interesting questions and answers about the health-care bill:

Q: What does the health-care bill do?

A: The bill would significantly change the $2.5 trillion U.S. health-care system that almost everyone agrees costs too much and leaves too many people without medical coverage. For the first time in U.S. history, citizens and legal residents will be required to purchase a health insurance policy.

Federal subsidies will be available to help them afford coverage. The subsidies will be available for people with incomes up to 400 percent of the poverty level, about $88,200 for a family of four. The poverty levels for 2009 is $22,050 a year for a family of four and $10,830 for an individual.

Small businesses will be able to tap into federal tax benefits to help buy medical plans for employees.

Employers are not required to provide health coverage for workers, but they would have to pay a penalty if any employees use federal subsidies to purchase insurance.

Q: Are there protections for consumers?

A: Yes. Insurance companies will no longer be able to deny coverage to anyone because of a pre-existing condition. They also will not be able to charge higher premiums because of gender, health history or occupation. Insurers also will be prohibited from dropping people when they get sick.

There will be no more lifetime limits on coverage and annual limits will be restricted. Insurers also will be required to cover preventive health-care services. Co-payments and other out of pocket expenses for beneficiaries also will be limited.

Q: What do insurance companies and hospitals get?

A: Insurance companies will get 31 million more customers, many of them subsidized by the federal government. However, in addition to new coverage regulations, insurers will be required to spend a minimum of 85 cents of every premium dollar on medical care for large group plans and 80 cents on every premium dollar for individual and small group plans.

By requiring everyone to obtain insurance, hospitals will have fewer cases of uncompensated care. Many people without insurance seek care at hospital emergency centers because they do not turn away patients. When patients are unable to pay, hospitals make up those losses by charging more to those with insurance. Democrats say that pushes premiums higher by about $1,100 a year.

Q: How does the bill reduce costs?

A: The bill seeks to save money by streamlining paperwork and providing more information to consumers to help them make decisions about their health-care.

Other cost savings will be driven through Medicare, the government health-care program for the elderly and Medicaid. Lawmakers hope that payment reforms that reward quality rather than quantity of services and treatments will help drive down costs. The bill aims to encourage coordinated care for patients particularly those with chronic conditions.

Studies have shown that better coordinated care can save significant amounts of money and improve the quality. The bill will provide for pilot programs to explore some of those cost saving methods for Medicare and Medicaid.

It also will encourage creation of Medical Homes and Accountable Care Organization where doctors, hospitals and other health providers can better coordinate care.

It’s scary to be denied health insurance or a job due to a health condition. It gets even worse when our medical records contain diagnoses and treatments for conditions we do not have or never have had. It might lead to a full-fledged denial of insurance or job. Other doctors may even end up misdiagnosing us or prescribing incorrect treatment based on the off beam information in our charts.

How can this happen, you ask?

This usually takes place due to doctors constantly having to authenticate their practices to the dictates of insurance companies. Insurance companies recompense for diagnostic testing and treatments for an ailment or condition, or even a symptom, but they do not rule out a disease or condition.

If one experiences persistent tingling in the hands, feet, lips and ears, few months down the line, one decides it needs to be checked. The primary physician may detect nothing wrong on examining. He may then refer you to a neurologist and may have you get a CT scan done. He may add tingling as the diagnosis, because the symptoms are all he has to go on.

Later, even the neurologist may detect nothing on the CT scan or on examining you but will want you to return for an EMG. He might also send you for an MRI to rule out multiple sclerosis. He may add a diagnosis of MS on the referral and the bill for the office visit, expecting your (very good) health insurance plan to cover tests for a diagnosis of MS.

The MRI might show a possible tightening around a nerve, but this wouldn’t necessarily cover the tingling on only one side of your body. Since you tingle on both sides, ‘pinched nerve’ isn’t really the correct diagnosis for you. But they’ve ruled out MS.

When you return back to the neurologist, expecting the EMG, he tells you that you must have carpal tunnel disease, because you spend your days working at a computer. That’s exactly what he must be looking for, so that’s what he finds. He completely ignores the tingling in your feet, earlobes and lips. And thus, carpal tunnel disease is added to the list of diagnoses on your medical record.

Your health insurance company now assumes that you have MS, a pinched nerve and carpal tunnel disease. That’s because it’s in their records of the claims filed for your medical bills. You will have none of these. You may have a mild tingling.

The incorrect diagnoses gets compounded, because the office clerk sees MS and carpal tunnel from the prior visits and puts that on all subsequent referrals and bills. It came from the doctor, so the question arises that why should it be questioned.

It would be very easy if we needed to apply for a private, individual health insurance plan.

Knowing the neurologist had tunnel vision about carpal tunnel disease, you may move on to another neurologist, who may confirms there’s no evidence of carpal tunnel or MS. At this point, he may detect some mild loss of temperature sensation, but has difficulties coming up with a firm diagnosis and so uses ends us using ‘peripheral neuropathy’ as his diagnosis. All ‘peripheral neuropathy’ basically means is that there’s something odd going on with your sense of touch. It’s a catch-all term that your symptoms fit into. It’s not as good as a diagnosis of a disease, because it suggests no treatment plan or prognosis. Insurance companies might cover testing for it. However, it may turn out better than a lot of incorrect diagnoses on your medical record, because you can be least assured that it is accurate.

It would make perfect sense for the insurance companies to just accept ‘rule out’ diagnosis codes and to pay for charges incurred for them. Because, the whole point of diagnostic testing is to find out what the problem is, and that very often involves ruling out certain possibilities. Another solution for doctors is labs, etc. to just use the diagnosis codes for the symptoms the patient is reporting. In this case, ‘tingling’ could be second-handed as the primary physician wrote. Or the physician could pick a generalized descriptive diagnosis like ‘peripheral neuropathy’ as the second neurologist did.

Unfortunately, patients cannot count on medical providers to do this. One has to have a look at what’s on the bills and in the records. Most of us wouldn’t know what the diagnosis codes meant.

Technology helps, because both procedure (CPT4) and diagnosis (ICD9) code translators are now on the Internet. With EHRs (electronic health records, the patient’s medical records) are becoming more available. This will enable us to see all the details right in our records. If we come across an incorrect diagnosis, we could then insist that we want it corrected.

We need to be meticulous about this if we don’t want incorrect medical information to take over and give us results in denial of coverage or in causing our physicians to miss a diagnosis or give the wrong treatment.

Interesting discussions have always caught our eye at Acroseas. As our research process, we came across this animated discussion on Linkedin talking about the confusion that are EMR/EHR Really Cutting Down Transcription Cost/Jobs??

The answers were intelligent and made us excited to share it with our industry with the power of a visual presentation embedded below:

The process of medical transcription is pretty simple. Almost all MT service-providers follow more or less the same method with slight variations.

The process of medical transcription can be outlined as below:-

Dictation :- Patient information is recorded by medical practitioners into a recording device. Choosing a superior voice quality device lends clarity, quality and accuracy to the dictations. Sometimes, sophisticated software modules are installed in the doctor’s PC that allow dictating and transmitting the voice files to the medical center’s server an easy process.

Transmission of Voice Files :- The digitally recorded dictations are transmitted from the medical practitioners’ PCs to the main server by making use of a memory card. From the server, these voice files are accessed by medical transcriptionist for transcribing. If medical transcription service is been outsourced, the voice files are routed/uploaded to the Medical Transcription Service Organization secure, encrypted server via the Internet, for transcription.

Transcribing :- Transcribers type the dictation word-to-word (except for making changes to grammar or usage errors) and convert the voice files into text format. Files are flagged off for the physician’s comments if the transcriptionist faces any clarity or inconsistency issues with them.

Quality assurance :- There are multiple levels of QA (Quality Assurance) in medical transcription and good service-providers offer a three-tiered quality assurance process.
In the initial stage, editing is done; the next stage involves proofreading of the entire transcribed word files to check for omissions and errors. In the final stage, medical editors do a thorough review of the completed files.

Sending back reports :- The completed medical records are sent as zipped email attachments or uploaded into the hospital’s server from where they can be accessed anytime by the doctor or the concerned staff for their respective use.

‘Personal’ got more personal with the HIPPA legislation setting out broad parameters for confidential sharing of medical records and health care information for the benefit of the patients and also the doctors in the long run.

Act and regulations- ‘Covered Entities’

HIPAA regulations have been crafted to have broad application. The provisions of the Act extend to all health care plans, health care providers who transmit health records in an electronic format, and health care clearinghouses and billing companies. The bill refers to these organizations as “Covered Entities”. However, almost everyone will be affected in one way or another by these regulations, which will impact both consumers and providers of health care services.

It is important to understand that state regulations may differ from national regulations and certain States may define MT Services as Covered Entities.

Role of Business Associates

As a Business Associate, a Medical Transcription Service may not be directly governed by HIPAA regulations. However, Business Associates are governed indirectly by virtue of the fact that Covered Entities are required to obtain written assurances from the Business Associates that they deal with to ensure that patient identifying information is appropriately safeguarded. These written assurances must be included in a written contract between the Covered Entity and the Business Associate.

These strict requirements guarantee vigilance in delivering evidence of compliance to the Business Associate partners.

Independent Medical Transcriptionists

Medical transcriptionists who operate as Independent Contractors to Medical Transcription Services (Business Associates) and who have direct access to patient health information are referred to by the Act as ‘Third Parties’. Third Parties ought to have a written contract with the Business Associate, assuring that the patient information conveyed, will be appropriately safeguarded. This contract should be similar in nature and scope to the contract between the Business Associate and the Covered Entity.

History of HIPAA

The rules became officially effective on April 14, 2001. However, the Act provided for a period of time before complete compliance was mandated. All other covered entities were required to become fully compliant by April 14, 2003.

Transmittal of Electronic Patient Information

The Act calls for the standardization of electronic document transmittal. The national standard which has been prescribed by HIPAA for electronic health record transmittal is ANSI X12. This national standard governs both the content and the format of patient information that is sent electronically between two organizations.

Key Provisions of the Act

* To restrict the dissemination of patient health care information.
* The rules specifically pertain to health information that is transmitted or maintained in any form (oral, paper, electronic, etc.) and which contains patient identifying information.
* In order to be compliant, covered entities must implement measures to ensure that patient information is protected in accordance with the provisions of the Act.

Protection of patient information

Written notification must be given to individuals telling them how information will be used and to whom it will be disseminated (Insurance and billing companies, or other health care practitioners, for example). Even written consent must be obtained from the individual allowing for the use and maintenance of personal information as provided by the Act.

Disclosure or use of information for any other purpose or to any other organization requires specific authorization from the individual. Reasonable efforts must be made by covered entities to minimize the dispersal of patient information. Health information can be conveyed to Business Associates (Business Associates” is a term that typically includes Medical Transcription Service Providers and their employees) only after written assurance is provided to guarantee the protection of the information.

Privacy officials must be appointed by each covered entity to develop, implement and oversee privacy policy for the covered organization. A primary contact person must also be designated to handle complaints and inquiries about the organization’s policy.

All employees of the covered entity must receive formal training to ensure that they understand the requirements of the privacy Act as they pertain to their specific duties. Covered entities must establish adequate administrative, technical and physical safeguards to ensure that all privacy requirements are upheld within the organization.

Penalties for Non-Compliance

The ACT states that, ‘Covered entities which fail to comply with the final regulations by the mandated compliance date may incur stiff penalties, including the payment of a fine’. In certain cases, criminal charges may be brought against the non-compliant entity.

Acroseas’ view

Considering all the measures that HIPAA lays out, we believe that this is a change for the better, for safeguarding the rights of patients. These measures ensure disclosure of information and hiring of privacy officials. It’s a significant step towards maintaining peace between the Business Associates and the Medical Transcriptionists.

Personal just got more personal with HIPPA developing an Act for confidential sharing of medical records and

health care information for the benefit of the patients and also the doctors in the long run.

Act and regulations- ‘Covered Entities’

HIPAA regulations have been crafted to have broad application. The provisions of the Act extend to all

Proponents of the technology say clinical documentation or the EHR’S via speech recognition builds a more complete patient record and help drive EHR adoption but there’s a flipside to this coin as well.

Problem of EHR’S

In general, most physicians love EHR systems (Electronic Health Records) for their ability to present information in an easy-to-access format. However, the idea of accumulation of patient information, being turned into data entry doesn’t fit too well for some. Another reason frequently given for poor EHR adoption rates are the templates and drop-down menus drive the patient interaction rather than serve as tools. Physicians report that the pre-structured responses and choices actually change or limit how they question patients. Their behavior portrays the technology rather than having it flow naturally to capture valuable action for diagnosis and treatment purposes.

Potential Solutions
To, effectively deal with these problems, some consider speech recognition technology because it enables physicians to interview patients in their customary manner and then dictate reports in free-form narrative. Two basic types of speech recognition technology are available: real-time (front-end) and background (back-end) systems.

Front-End Speech Recognition

Front-end speech recognition occurs in real time during the documentation process. The physician logs into the EHR system or opens a Microsoft Word document and dictates into a microphone or a headset. As he or she is speaking, the words the speech recognizer hears appear on the screen instantaneously. When the dictation is finished, the physician reviews the words on the screen, makes any corrections, signs it, and files it in the EHR.

Errors can occur when physicians don’t talk directly into the microphone, don’t pay attention to what they’re saying, or just don’t talk clearly. Transcriptionists identify the errors and return the document to the physician to correct and sign off. Corrections are then made by the physician in the electronic health record.

Speech recognition is so accurate that some physicians can dictate 30 to 40 charts with only one or two errors. The technology is ready for prime time, say proponents

Efficiency of speech recognition

The efficiency of speech recognition can be further enhanced through the use of macros, or subroutines within the software that extract information from the EHR. Using macros, one can reinstate dictation with the patient’s medical history, social history, family history, and the like.

The Next Evolution
Speech recognition delivers significant productivity improvements and eliminates the problem of forcing physicians to think and question patients according to EHR templates and drop-down menus. However, the technology faces one major hurdle. It cannot convert the free-form narrative produced by clinicians into structured information that can be data mined and queried by clinical systems. This also means coding and billing cannot be done automatically. Coders and billers have to review and code charts in the traditional way.

That’s where speech understanding comes in. It not only listens and transcribes, but it actually understands what the physician or clinician is saying and converts it into a structured document. It attaches semantically interoperable tags and values to the information so that computers can read it without human intervention.

Do’s and don’ts’ on Sound Input Devices
Speech recognition technologies have the potential to provide huge savings in transcription costs, but cutting corners on microphones will decrease reliability and negate some of those benefits. To take full advantage of today’s accurate speech recognizers, experts say it is wise to invest in high-quality sound input devices.

Acroseas view

We believe that speech recognition is not as evolved or advanced as many doctors would like it to be. The output of the speech recognition software has to be proofread by an MT or a doctor himself. Now that 32 million more Americans are going to come under the umbrella of health insurance, we can take it for granted that the workload of the doctors is going to increase. Doctors do not want to waste their time proofreading documents generated by speech recognition programs. The doctors want to spend as much time with the patients as possible, as this is their job. Thus human MTs are not going anywhere, and by extension, outsourcing medical transcription work to cheaper offshore locations is also not going away anytime soon.